RCEM Conference 2025: Reflections from Day 1

By Joey Godfrey | Shared with permission on St Emlyn’s Blog

Day 1 of the RCEM Conference 2025 opened with a sense of urgency—and a lot of honesty. From defining our place in a changing NHS to grappling with our own wellbeing, the day brought insights, uncomfortable truths, and calls to action. Here’s my reflection on some of the major themes and conversations that shaped the day.

“If We Don’t Define EM, Someone Else Will”

RCEM President Adrian Boyle set the tone with a powerful challenge: Emergency Medicine must take the lead in defining its own identity. The launch of the Guidelines for the Provision of Medical Services (GPEMS) document is a step towards that, and he urged everyone to read it (link here). With NHS England’s restructuring looming large, the implications for recruitment, procurement, and departmental autonomy are significant.

The stats don’t lie. There were 2,700 applicants for just 360 EM training posts. That’s a sharp reality check—and a reminder that while interest is high, opportunity is limited. On the ground, we are confronting a mismatch between capacity and demand. Boyle pointed to the troubling trend of EM clinicians leaving the specialist register at the highest rate of any specialty.

He was clear that RCEM does not currently support the use of Physician Associates in EM, citing the training burden and clinical risk. He also acknowledged anxiety about consultant posts: while the aspirational ratio is one consultant per 4,000 attendances, we’re currently closer to 1:7,000. An estimated 200 consultant vacancies are predicted across the UK this year.

There are big plans on the horizon—reforms, workforce reviews, and the lingering hope of a long-term strategy. But the message was clear: we need to define ourselves, or risk being defined by others.

Living Well in EM: Health, Habits and Resilience

Dr. Romila Bahl’s session was a breath of fresh air—literally. Framed around the simple idea of “Eat, sleep, work, rest and play”, she challenged us to consider how often we truly care for ourselves in a meaningful way.

Her practical advice was rooted in both evidence and experience. She encouraged:

Reducing processed foods and sugary snacks
Supplementing Vitamin D, especially for shift workers
Avoiding caffeine after 3pm
Choosing nuts or dark chocolate over crisps
Getting 7–8 hours of sleep in a cool, dark room

More than just lifestyle tips, she focused on internal and external barriers to well-being. Financial pressures, family life, departmental culture, and personal motivation all play a role. She reminded us to challenge the culture of staying late on shift—does the secondary gain really outweigh the primary loss?

In a specialty known for burnout and moral injury, her message about preserving autonomy and investing in ourselves felt especially timely.

Out-of-Hospital Cardiac Arrest: Technology Meets Reality

The conversation shifted toward Out of Hospital Cardiac Arrest, where new tech is emerging—but so are familiar challenges. Only 9% of patients survive to discharge, and most arrests are still unwitnessed.

We heard about the potential of wearables to detect cardiac arrest, automatically call 999, and even guide bystanders via video. But when it comes to innovations like head-up CPR, the evidence remains limited.

One striking point: outcomes for women are worse, in part due to hesitance around AED use. There’s now a campaign to encourage removal of bras during CPR to improve pad placement.

Other developments included:

Ultraportable AEDs: being trialled, though efficacy is unclear
Drone-delivered AEDs (as in Sweden): saved 3 minutes on average, but had limited use (only 3 shocks delivered from 200 calls)
Advanced defibrillation strategies (e.g., dual sequence/vector change) showing promise
Whole-body CT post-arrest improving outcomes and although not in the current guidelines may be something we need to consider.

Meanwhile, vascular access data suggests IV first may edge out IO first for achieving ROSC. And trials like ARREST raise questions about the routine use of PCI in all post-arrest patients, although it was arguably very specific to the London health economy and geographical distribution of services.

The Pre-Alert Problem

Dr. Caroline Leech spoke frankly about the state of pre-alerts. A new national guideline is coming, and not before time. Pre-alerts, once a cornerstone of safe Resus planning, are now hindered by overcrowding, capacity limits, and miscommunication.

Paramedics report limited training, frequent interruptions, and anxiety about making pre-alert calls. Many feel judged if their patient doesn’t end up in Resus, even though 1 in 3 calls are actually requests for clinical advice. There is research ongoing in this area.

The take-home? We need shared language, better mutual understanding of prehospital pathways, and maybe even the return of ED staff spending time on the road with ambulance colleagues.

Clinical Pearls from the Field (Rugby, PHEM and adolescent sports)

There were plenty of punchy clinical takeaways throughout this session. Underlying this session was a feeling that as EM clinicians we have lost some of the exposure and interest in musculoskeletal injury. That’s a real shame as it can be an incredibly rewarding and interesting (and it’s also part of the curriculum!).

Laura Owen used a case-based approach to explore cognitive bias and decision-making in prehospital care. She used some cases that we can;t reproduce here for obvious reasons, but the key messages were that experience in PHEM can make you a better EM doctor. Some of that will be about the clinical skills, but arguably there is much more about the human factor elements. Laura highlighted that we make a lot of time critical information light decisions. These might appear to be decisions that need to be rushed, but she succesfully explained why a pause and a formulated plan, based on experience and the careful establishment of situational awareness really make a difference. It was a really fantastic talk.
Karen Jones, England Rugby doctor, delved into concussion: half of all cases go unreported, second impact syndrome is rare but catastrophic, and a cautious return-to-play approach is essential. MicroRNA blood tests and sensor-equipped mouthguards might soon offer objective concussion diagnostics.
Kim Gregory reminded us that normal imaging doesn’t mean no injury. Recovery should be function-based, not dictated by time. Occult NOFs in the hip, subtle signs on the knee (Segond fractures), and lingering ankle issues all need careful assessment—especially as ED summaries often miss key findings. I think everyone in the room will be going away from this talk with a greater appetite for MR scanning in MSK disease, and also a desire to ensure that MSK injury that does not settle has a really robust follow up system.

EM Is a Risky Business: Panel Reflections

The afternoon panel tackled systemic risks head-on.

Adrian Boyle returned to the topic of ED crowding. He cited ONS data showing mortality rates doubling between 2 and 12 hours in ED, even after adjusting for comorbidities. Social care delays account for 60% of long inpatient stays. During junior doctor strikes, discharge rates actually improved—a striking illustration of how elective pauses can free up space and flow.

His mantra? We need Staff, Space, Systems, and Stuff. The 4-hour target, while useful, doesn’t address the back end of the ED journey, where risk accumulates.

Katherine Henderson focused on missed fractures and their cost to both patients and the NHS. She cited reports from NHS Resolution showing that in over a third of missed fracture claims, no appropriate X-ray was taken. She reiterated the importance of following RCEM’s investigation results guidance and ensuring imaging is escalated when clinical concerns persist.

Everyone agreed that any guideline related to risk/imaging/litigation/investigation/treatment in the ED…….. MUST include EM clinicians in their construction and MUST be achievable in practice. The example of a well known guideline that states that MR scanning must be available within 2 hours (written without RCEM endorsement) will fail, and we won’t do it, so it’s rubbish.

Ageing in EM: Valuing Experience

Higgi’s talk (our president in waiting) was a beautiful reflection on age, experience, and value. With more consultants staying in EM longer, we must shift from ageism to inclusion. Physiological changes—from hearing loss to sleep disruption—are real, but so is the wisdom and calm that older clinicians bring.

His message was simple: design departments that value all ages. Use ergonomic workstations, support cognitive load, offer flexible shifts, and match people to the work that energises them. And when it’s time to retire, let it be a positive, voluntary transition, not one forced by burnout or bias.

Final Thoughts

From the existential (“What is EM?”) to the everyday (“Why do I stay late on shift?”), Day 1 of RCEM 2025 was a whirlwind of ideas, honesty, and challenge. There’s plenty to reflect on—and even more to take back to our departments.

Thanks to all the speakers, organisers, and especially to Joey Godfrey for this fantastic summary.

Joey Godrey (EM consultant)

Simon Carley